Public Health Message, Shadow 2504
by Sahlinrob
Summary: A suplement to "Firefly Season One."


**A/N 1... **This is presented as a supplement to my main story (Firefly Season One). However, if you have not been keeping up with it, you still might find it an interesting read, though some may find it a bit "dry;" like reading a textbook.

There is no action or dialog. It's presented as if it were a reproduction of a public awareness brochure or pamphlet on a public health issue that existed on Shadow, before the war. (Like the pamphlets you might find in a doctor's waiting room)

Only three characters are even mentioned, two of which are OC's from my main story. They are Dr. Mathias (From Academy fame), Dr. Mouer (The Reynolds family physician, before the war) and Stacy Reynolds (Malcolm Reynolds' young daughter, also from before the war)

**A/N 2... **If you are another active writer and if the medical condition described here interests you, feel free to us it as an element in one of your own stories, if you want. The only thing I ask is that you keep it true to cannon. "Cannon" being the way I have described it. If you have any questions on that matter, feel free to PM me.

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**Common Questions and What all Shadonian's Should know about HRS. (Human Rabietic Syndrome, **Latin, "fury" rabere "rave, be mad"**)**

**By Maxwell Mouer; MD.**

**Published: 3/24/2504 **

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**Question: What is HRS?**

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**Answer: **HRS, also colloquially known as "The Curse of Shadow," "Shadow Madness," "The Devil's Touch" or simply "The Curse," is a rare condition, (exclusive to Shadow) that brings upon a progressive degeneration of the central nervous system that, in time, completely hijacks the brain of the afflicted.

It manifests itself and progresses in a series of violent psychotic episodes or "fits," characterized by irrational paranoia, delirium, hysteria, cannibalism, surges of near super human strength and wild, uncontrollable psychotic rampages of destructive, homicidal and even self destructive behavior. Also excessive salivation, contraction of the pupils with the irises taking on a strange yellowish hue, screaming frantically, as if in some strange incomprehensible unknown language and in the latter, more severe attacks, perhaps even feeding off one's own flesh.

Durring a fit, the afflicted will, barehanded or with improvised weapons, lash out at anything in the immediate vicinity, be it human, animal, plant or even inanimate, with astounding force and strength. This will continue until the subject collapses in a state of complete physical exhaustion (About 10-15 minutes).

When consciousness is regained they're generally returned to a rational state of mind, but in a state of total confusion, with little or no recollection of their previous rampage of destruction.

The time period between the initial occurrence and the next can be as short as a few hours to as long as two weeks. This time period generally sets the standard for the periods of sanity, between subsequent fits, but becomes drastically reduced as the condition progresses. The ferocity and strength, exhibited by the afflicted during following psychotic episodes, also increases dramatically until in the final stage, the hijacked brain pushes the body to commit acts of violence that far exceeds what it can physically endure. (There have been cases where the afflicted have punched through walls with such force as to not only shatter the bones in their hands and arms, but to actually tear the flesh from their limbs.)

Death comes from cardiac arrest and/or the effects of self mutilation. (i.e. excessive bleeding). This is provided that somebody hasn't put him/her out of their misery, typically in self defense. (In the latter episodes, an afflicted person can be nearly impossible to subdue, without the use of lethal force)

Average life expectancy, after the initial occurrence, is about three weeks, if immediate medical attention is not sought.

Untreated, it has a 100% mortality rate.

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**Question: Is there a cure?**

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**Answer: **Dr. Mathew Mathias, of the Anglo-Sino Center for Behavioral and Medical Research has been working on a possible cure, for this horrific malady, for several years. Unfortunately, at the time of this publication, he has been unsuccessful in finding one, let alone, having it approved by the Medical Elect.

For the last twenty years, however, there has been a "treatment" (not a cure) available, to the sufferers of this most horrific of afflictions.

Treatment consists of injections of a Paxilon Hydroclorate derivative, that should begin before the second occurrence, ideally and absolutely prior to the fourth. (Treatment started durring the first "calm period" has enjoyed a 100% success rate; 80% durring the second, 50% durring the third, but drops off to 5% or less after that.)

At the present time, a patient, of this most hideous condition, can enjoy a perfectly normal, healthy and productive life. I must stress however that it is not a "cure," only a reprieve from the inevitable, in hopes that durring that time, a cure might be found. It is always inside, like an evil djinn in a bottle, just waiting for the day it will be freed.

The problem is that the human body, afflicted with HRS, gradually builds up a resistance, to the only known medication. In time, it becomes completely ineffective and the occurrences return, with a vengeance, almost as if the disease was "making up for lost time."

However with a proper treatment regimen, this end can be forestalled for anywhere from seven to fifteen years. It's a sad and ironic fact, however, that those who are in the best of health with remarkably immune systems, such as case# 123-R; Miss Stacy Reynolds, (The only living person with "full blown" clinical HRS, at this time) weigh in at the low end of this curve. I have been treating Miss Reynolds since she was first afflicted at age twelve. She is presently an extreamly robust and vivacious young lady of sixteen years, but her equally robust immune system is developing a resistance to her medication, at an alarming rate. It is highly doubtful that she will ever celebrate her nineteenth birthday.

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**Question: Is HRS contagious?**

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**Answer:** Studies and tests, on past HRS patients, have never shown any type of unusual pathogens, in their systems, to leed one to believe that this condition is in any way infectious. The only changes are minute changes in the chemical composition of the patient's spinal fluid, that can only be detected at the most advanced medical laboratories.

You can not simply "catch" HRS from somebody, anymore that you could catch epilepsy.

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**Question: How do I know if I am at risk of developing HRS** **and what are the early symptoms?**

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**Answer: **While statistically speaking, the risk is only about 100:1 against ever developing HRS, if you have lived on Shadow for any length of time, you _are_ at risk; it's that simple.

There are _no_ "early symptoms," prior to the initial "fit." This first psychotic episode is, in effect, the first outward symptom and by this time, the condition is fully developed; you now have "clinical" HRS. Again, if the proper treatment is administered at that time, in a timely fashion, you will recieve a reprieve for many years, but in the end it is still a horrible death sentence.

In centuries past, there have been many hideous, beyond description, diseases that have preyed upon humankind, but none can compare with HRS. I have practiced medicine on Shadow for forty five years and have had the misfortune to witness many cases, long before there was even a _treatment_ available. You can never forget the sight of someone screaming in terror and hysterics, frothing at the mouth while strapped down in a bed, as they fight against the restraints until they cut to the bone. It takes a long time to erase from your memory the stricken, tear filled face of a father that has just ended his child's suffering with a shotgun, knowing that not even the most powerful sedatives would work at that point and a quick death was the only remaining hope.

Fortunately, within the last five years, a new testing procedure has been developed. A series of spinal taps and subsequent analysis of the spinal fluids, can determine if this condition could be developing in your system. If treatment is initiated _prior_ to the first occurrence, while you will always have HRS, in it's pre-clinical stage, there is a 95% chance that it may never fully develop into "full blown" clinical HRS and you will live a normal life, for as long as God had originally intended, provided you stay on your medications.

In closing, if you're a native Shadonian you're at risk; take the test and if it comes back positive, take the treatments.

HRS is quite rare, some have never even heard of it, but even one chance in a hundred is too great a risk, when dealing with somthing like this. Don't take that chance.

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**Question: What is the cost of testing and treatment. What does it consist of? Will I need to go to an expensive hospital in the Core?**

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**Answer:** Lab testing, for pre-clinical HRS, is provided free of charge by the Anglo-Sino Medical Outreach Program.

Testing consists of having a spinal tap taken once a week, over a four to five week time period. The fluid samples are sent to a Lab in Londinium, for analysis. This can be done by your regular physician, to whom will be the only expense you should incur. As most doctors on Shadow make "House Calls," it can be done in your own home.

If the test results are positive and you wish to have "preventative treatment," there will however be charges for the medications. They are a highly controlled and regulated substance and can only be obtained by your doctor, through a federal dispensary. While they are somewhat costly, in "hardship cases" they will be provided on an "ability to pay" basis and considering the alternatives, they are worth every platinum you might have to spend.

Preventative treatment consists of an initial series of injections (two per day over a two week period, which can be self administered) of the same Paxilon Hydroclorate derivative used for "remedial treatment," only in much less concentrated (and less expensive) dosages. Durring the initial series of injections you may experience mild side effects, including; occasional nausea, dizziness and lethargy. With due prudence, however, you should be able to carry on with your normal activities and duties durring this period. By the third week, all side effects should disappear.

After the initial treatment, you will need to have semi-annual injections as a "booster" (there should be no side effects). Federal law also requires that an annual spinal tap be taken and sent to the Anglo-Sino Center for Behavioral and Medical Research, in either Londinium or Sihnon for analysis, but you should never have to leave Shadow or be hospitalized.

If you have experienced the first occurrence and have full blown clinical HRS, you will require "remedial treatment." While the process is similar, it is much more intensive and costly.

The initial series of injections jumps from two per day to possibly six and in highly concentrated dosages. Depending on the severity of the condition, the dosage needed may approach lethal levels. Medications will need to be administered to combat the many severe side effects, which may include; extreme depression and lethargy, inability to eat or drink, convulsions, delirium and even respiratory failure.

Durring this period (Which may be as long as eight weeks, as opposed to two), you will need to be under the care of a physician experienced in HRS treatment, in a medical facility with a fully equipped ICU. There are two such facilities on Shadow, so going "off world" should not be necessary.

After the initial treatment is completed and your condition is stabilized, you will be discharged, but may require a physical rehabilitation program. Complete recovery can take as long as a year.

While they can be self administered and will produce little if any side effects, you will need to continue with booster injections, on anywhere from a daily to weekly basis, depending on the severity of the initial occurrence and how quickly treatment was initiated thereafter.

Also, by law, anyone undergoing treatment for clinical_ or _pre clinical HRS must register with the Anglo-Sino Center for Behavioral and Medical Research in either Londinium or Sihnon. Those with _clinical_ HRS must also report there for annual tests and examinations. Part of the problem with finding a cure is the rarity of the condition and so few actual living cases available for study. It is only by compliance with this law that the treatment drugs can be obtained.

By careful analysis of the patient's spinal fluid, the effectiveness of the medications (boosters) and conversely the progression of the disease can be monitored. As long as the chemical composition, of the fluid samples, remains stable, the medications are believed to still be 100% effective. When changes are noticed, it is indicative of the affliction resuming it's progress and the medications loosing their effectiveness. As the rate of change increases, the yearly examinations are stepped up to biannually and then quarterly. In this way, a relatively accurate prediction can be made (within a month's time) as to the time when the affliction will fully resurface.

At this point (when resurgence is deemed imminent) it has been suggested, by the Medical Elect, that sufferers of this affliction be retained in "medical custody" and secure isolation, for further study and as a safeguard to the general public. Presently however, you are still free to decide your own fate and how the safety of those around you will be insured. Painful choices and decisions must be made by you and your loved ones, in a timely fashion; once the medication becomes ineffective, an extreamly violent relapse can occur at any time, with very little warning.

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**Question: If I test positive for HRS, would relocating to another world be sufficient for prevention, in lieu of participating in an Alliance controlled treatment program and complying with their regulations? It is my understanding that there has never been a reported case of HRS off of Shadow.**

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**Answer: **There _has_ been some controversy of this subject and it is true that all reported cases have occured on Shadow; HRS is in fact unique to this world.

While not proven, it is the general consensus, of those who have studied this affliction, that whatever it is on Shadow that starts the changes, in your central nervous system, is just a "trigger." One the changes are triggered they become self sustaining.

When you test positive, although you have never experienced a HRS fit, you still have the affliction growing in your system. It's self sustaining and only a matter of time before the first occurrence. Relocating to another environment would probably have little if any effect on it's progress.

As far as HRS never appearing on another world, you must also remember that the emigration rate from Shadow to other worlds is extreamly low (Less than .001% of the population per year). That, coupled with the fact that HRS is quite rare, would make it extreamly unlikely to occur anywhere else. There could always be a first time though; don't take the chance and be that first.

If you test positive get the treatment, Alliance controlled or not.

I myself am a native born Shadonian and other than my years in medical school, have lived here my entire life. I can not think of another world where I would rather be. That said, I fully understand and can appreciate the views that most, if not all, of my fellow Shadonians hold toward the Alliance and reluctance to come under their control in any way.

But to be perfectly fair, for all their faults, they have made tremendous advances in medical science. By compliance with their program concerning HRS, you might not only be saving yourself, from a horrible fate, but perhaps even your unborn children. The more cases they have to study the greater the chance that they will find the means to completely eradicate this hideous affliction, so that future generations of Shadonians might never have need to worry.

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**Question: If someone I know goes off on a violent rampage, how do I know if HRS is the cause? How do I know, whether or not, that it's not just the result of over indulgence in alcohol, a drug reaction, heat stroke or any number of other possibilities? If it is HRS, what can I do to help them?**

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**Answer: **The most striking feature of an HRS attack, is the subject performing unbelievable feats of strength. While certain drugs can produce similar effects, they are nowhere near the magnitude of the ones exhibited by a person durring an HRS attack.

Secondly, the subject will typically be screaming incomprehensible nonsense, but it will seem to be clearly enunciated speech in an unknown language, as opposed to simple slurring or using normal and familiar words, in an incoherent and/or disjointed manor.

Finally, another striking feature is the eyes taking on a bright golden yellowish coloration, with constricted pupils; in bright sunlight they will constrict down to mere pin-pricks.

Naturally, the first response should be an attempt to physically restrain them, to prevent injury to themselves and those around them. This, however, can be a rather difficult task and you must remember that a person under the influence of HRS will be extreamly aggressive and can be quite dangerous.

As an example; Miss Reynolds was only twelve years old at the time of her first HRS fit. She was under five feet tall and weighed less than eighty pounds. Still, it required the team effort of five full grown men to stop her, but not before she had injured several others, some seriously.

**Do not attempt this yourself**. If the manpower is not available, the best course of action is to try and "bait them," to come after you and keep out of their way, until they collapse from exhaustion. This can take up to fifteen minutes though and even longer in some cases and should be done with extreme caution.

After they are subdued or collapse on their own, lf possible, they should immediately be restrained in a bed. Ideally, the bed should have a frame of heavy metal or Baobab wood construction. The restraints should be securely attached to the frame and be of thick leather, if possible.

**Do not use metal restraints, **if at all possible, (i.e. handcuffs, chains, wire rope, etc.) If another fit occurs, HRS patients have been known to nearly sever a limb while attempting escape, if such devices are used.

Ideally, a restraints should be securely attached to the patients ankles, wrists, across the hips, chest and forehead. Also, if one is available, a chin strap should also be employed. (Bed bound HRS patients have been known to thrash their heads around, with such intensity, as to break their own necks.)

A thick leather gag is also imperative, to prevent them from biting off their own tongue, should another fit occur or if they should awaken in the same state.

After the patient has been secured, call a medical professional. Preferably one with prior HRS experience. Time is of the essence here. The sooner treatment can begin, the better the chances that it will be successful.

When the patient awakens, in most cases, they will be restored to a rational state of mind, but will be extreamly disoriented, dazed and confused. It is not uncommon for them being unable to recognize even close friends, family members, or even remember who they are.

The time period between the first and second occurrence is, on the average, about four days, but can be less than an hour. If this should happen, before Medical assistance arrives, **do not under any circumstances use drugs **to sedate the patient. The wrong drugs, or dosages can have very unpredictable results, durring an HRS attack. Sedation may have the reverse effect and actually cause stimulation, respiratory failure and/or cardiac arrest. This should only be attempted by a trained professional, well versed in HRS treatment. The only thing you can do, as painful as it might be, is to just make sure he/she is securely restrained, stand back and let them "ride it out." Until a physician arrives, there is nothing more that can be done for them.

No matter how rational the patient becomes, he/she **must remain securely restrained. **If another attack occurs, it will come suddenly and without warning. Until treatment is well under way and spinal tap tests show that the condition has begun to stabilize, they are quite literally a "ticking time bomb."

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**Question: What is the cause of HRS? Where did it originate?**

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**Answer: **The terraforming of Shadow began in 2364. By 2389, atmospheric pressures and the planet's magnetic field became sufficient to ward off ultraviolet and cosmic radiation, so that pressure suits and other protective clothing were no longer necessary. The terraforming crews could now work in "shirt sleeves," but as the oxygen levels were still not high enough to sustain human life, they still had to wear oxygen masks over their faces. By 2394 the air was breathable and the respirators were finally discarded.

It was in that year that the first suspected cases of HRS occurred. Workers started going off on a crazed senseless murder binges, for no apparent reason. As the planet was still in the terraforming process and was not open for colonization, with the exception of the company security guards, law enforcement was non-existent, as were any but the most rudimentary medical facilities.

There was never any investigation and there were never any autopsies preformed on the bodies, after they finally succumbed to the affliction or were shot. It was assumed, that it was a result of recreational drug usage, that was running rampant among the crews at the time. More security guards were brought in and there was a major crack-down on black market drugs. After the crackdown, these psychotic incidents seemed to taper off. Figuring the problem was solved, all was forgotten and it was back to work as usual.

In 2404, terraforming was completed and Shadow was opened to colonization. By 2406 settlers from Bernadette were pouring in by the droves and a year later the disease started popping up again, with even greater frequency. While HRS is quite rare today and has been for decades, from 2410 thu 2418 it was becoming commonplace and in some areas, almost epidemic. There was a great scare; rumors spread that somthing had gone wrong durring the terraforming process and the air and soil had been poisoned. Many even believed that Shadow had been the abode of demons and evil spirits, that were now taking revenge on the trespassers, for defiling their homeland. A mass exodus occurred and the immigration of new settlers all but dried up. In the following two years Shadow's population plummeted from over 300,000 to just over 13,000, where it has more or less remained to this day. Whether or not the refugees that fled had picked up HRS durring their stay here and succumbed to it later on another world is unknown. Most resettled on other newly terraformed and sparsely populated worlds, where record keeping had not yet began. It is very possible that this might have happened, but if it did, there is no record of it.

It's ironic that the quality of life we enjoy here, due to the low population density, is due to this dreaded affliction.

After 2421, except for a few isolated cases, which may or may not be true (it was still not recognized, by the Medical Elect, as an actual medical condition at the time and was not recorded in medical journals), it all but disappeared.

From 2447 to 2455 there was another outbreak and it was durring this time that the Medical Elect finally recognized it as a medical condition and federal funds were allocated for studies. Unfortunately, by the time a task force was put together and arrived here on Shadow to begin a research project, in September of 2454, there was less than five months left before the disease went back into hiding. All but five from the original task force of thirty were recalled back to Londinium, but the five who remained continued on studying the occasional isolated cases that would occur. When there were no active cases, they would conduct experiments with everything from soil samples and well water; to plant material and animal droppings.

The only thing that was discovered, that was out of the ordinary, was an odd unknown spore. Samples of these spores were sent to a prominent university in Sihnon, where they theorized that they may have existed in the dusts of Shadow, in a dormant state, for eons before humankind had ever left Earth-That-Was and the terraforming had brought them back to life. Hopes that these were the root cause of HRS were all but dashed a few years latter, however, when the same spores were found on Brisingamen and it's moons (Freya, Alberich and Beowulf).

There are some, in the scientific community, that still maintain that these alien spores could be the elusive killer. While there has never been a reported case of HRS from that system, many of the cultures there exist in such a savage and barbaric state that a person afflicted with HRS might not attract too much attention and therefore go unreported.

Others argue, that while there _are_ many savage societies there, there are also some that are very civilized and peaceful, especially on the main planet of Brisingamen, where the highest concentration of spores were found.

Also, Brisingamen and it's moons had been terraformed and had had human populations since 2300 (a full century before Shadow became habitable). It also has a population of over seventy four million, compared to Shadow's thirteen thousand. Even it's tiny and least populous moon, Beowulf, has over a million and in over two hundred years among millions of inhabitants, not one reported case of HRS.

While I personally am still open minded, on the spore theory, I don't think it's very likely and that might be for the best.

These little microscopic half life creatures, when ever somthing seems to threaten their existence, simply revert back to a dormant state, in which nothing we know of seems to be able to harm them, that wouldn't kill a human host as well. Anything that could purge them from the air, water and soil on Shadow would destroy every other form of life, from the simplest single celled microbe to plants animals and humans, long before it even drove these hardy little space creatures back to a dormant state. They've been around for perhaps millions of years; on a lifeless, waterless, airless rock, in the cold vacuum of space. Since before mankind's far distant progenitors spawned in some ancient primordial soup, back on Earth-That-Was, they could have been here, enduring every form of deadly cosmic radiation that we know of and they still exist today. This is their home and they're not leaving.

The origins and root causes, of this strange and deadly affliction, is as much a mystery today as it was a century ago. Still, we _do_ know that whatever it is that brings it on is most likely breathed in; the original occurrences on the terraforming crews started soon after they started breathing the new atmosphere.

Historical record also shows that it seems to come and go in random cycles. While Miss Reynolds is the only living case of full blown clinical HRS today, in the last several years there have been many pre-clinical cases discovered, with the new testing procedure. This disease may be getting ready for another come-back. Fortunately, those who have tested positive have all elected to go ahead with the treatment program and no new full blown cases have occurred, to this date.

In light of how little we actually know, about this dreadful affliction, it's nothing short of a miracle that we now have the means to prevent this disease from ever claiming another victim. Alliance or not, my hat's off to Dr. Mathias and his team, who have spearheaded a new campaign against this merciless killer.

In times past and even today, in less enlightened and superstitious communities, sufferers of this condition were thought to be "demon possessed" and dealt with accordingly (i.e. burned at the stake). As an educated man and a member of the medical profession, I am of course, appalled by such ignorant and barbaric practices. Still, I am inclined to believe that the victims of this ignorance suffered a far more humane and merciful fate, than had the affliction been allowed to run it's full course.

As rare as it is, it is largely overlooked and even forgotten by most people today, but the chance of contracting HRS is nothing to be taken lightly, no matter how slight that chance may be. With the tools we have today, there is no excuse to allow yourself or _any_ of your loved ones to suffer the horrific end, that HRS will ultimately deliver.

Miss Stacy Reynolds knows full well that this could be _her_ fate, in just a few more years. Still, with this "Sword of Damocles" hanging over her head, since the age of twelve, she has gone on to be quite an accomplished person, for only being sixteen years of age. She's a brave and remarkable young lady. Anyone that knows her personally also knows that her political views are as anti Alliance, or anti _anything_ that comes from the Core, as one can be and can be quite outspoken about it. Still, she has made several appearances on the Core-View, urging the people of Shadow to swallow their pride, when it comes to HRS and go along with the new testing procedure, as do I.

If you're a Shadonian and especially if you're native born, get tested, at your earliest possible opportunity.

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